Treatment of multiple adjacent Miller Class I and II gingival recessions with collagen matrix and the modified coronally advanced tunnel technique.

OBJECTIVE: To clinically evaluate the treatment of Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a newly developed bioresorbable collagen matrix of porcine origin. METHOD AND MATERIALS: Eight healthy patients exhibiting at least three multiple Miller Class I and II multiple adjacent gingival recessions (a total of 42 recessions) were consecutively treated by means of the modified coronally advanced tunnel technique and collagen matrix. The following clinical parameters were assessed at baseline and 12 months postoperatively: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD), recession depth (RD), recession width (RW), keratinized tissue thickness (KTT), and keratinized tissue width (KTW). The primary outcome variable was complete root coverage. RESULTS: Neither allergic reactions nor soft tissue irritations or matrix exfoliations occurred. Postoperative pain and discomfort were reported to be low, and patient acceptance was generally high. At 12 months, complete root coverage was obtained in 2 out of the 8 patients and 30 of the 42 recessions (71%). CONCLUSION: Within their limits, the present results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions by means of the modified coronally advanced tunnel technique and collagen matrix may result in statistically and clinically significant complete root coverage. Further studies are warranted to evaluate the performance of collagen matrix compared with connective tissue grafts and other soft tissue grafts.

Treatment of class III multiple gingival recessions: a randomized-clinical trial.

BACKGROUND: The aim of this controlled randomized split-mouth study was to evaluate whether a modified tunnel/connective tissue graft (CTG) technique - enamel matrix derivative (EMD) combination will improve the treatment of multiple class III recession when compared with the same technique alone. MATERIALS AND METHODS: Twenty healthy subjects with a mean age of 31.7 years, were enrolled for the trial in a university periodontal clinic. Patients with at least three adjacent gingival recessions on both sides of the mouth were treated with a modified tunnel/CTG technique. On the test side, an EMD was used in addition. Clinical parameters were measured at baseline, 28 days, 3, 6 and 12 months after the surgery. Results are presented at the subject level. RESULTS: The mean root coverage from baseline to 1 year post-surgery was 82% for the test group and 83% for the control group. Complete root coverage was achieved at 1 year in eight (38%) of the 20 surgeries (experimental and control group). CONCLUSIONS: One-year results indicate that the modified tunnel/CTG technique is predictable for the treatment of multiple class III recession-type defects. The addition of EMD does not enhance the mean clinical outcomes.

Clinical evaluation of a modified coronally advanced flap alone or in combination with a platelet-rich fibrin membrane for the treatment of adjacent multiple gingival recessions: a 6-month study.

BACKGROUND: The aim of this study was to determine whether the addition of an autologous platelet-rich fibrin clot (PRF) to a modified coronally advanced flap (MCAF) (test group) would improve the clinical outcome compared to an MCAF alone (control group) for the treatment of multiple gingival recessions. METHODS: Twenty subjects, presenting three adjacent Miller Class I or II multiple gingival recessions of similar extent on both sides of the mouth, were enrolled in the study. The mean recession value at baseline was 2.9 +/- 1.1 mm for test sites and 2.5 +/- 0.9 mm for control sites. Each patient was treated on both sides by an MCAF technique; the combination treatment (with a PRF membrane) was applied on the test side. Probing depth (PD), recession width, clinical attachment level (CAL), keratinized gingival width, and gingival/mucosal thickness (GTH) were measured at baseline and at 6 months post-surgery. Gingival recession was measured at baseline and at 1, 3, and 6 months post-surgery. RESULTS: Mean root coverage after 1, 3, and 6 months was 81.0% +/- 16.6%, 76.1% +/- 17.7%, and 80.7% +/- 14.7%, respectively, at the test sites and 86.7% +/- 16.6%, 88.2% +/- 16.9%, and 91.5% +/- 11.4%, respectively, at the control sites. Differences between the two groups were statistically significant at 3 and 6 months. At 6 months, complete root coverage was obtained at 74.6% of the sites treated with the control procedure but at only 52.2% of the experimental sites. At 6 months, the increase in GTH was statistically significant when comparing the test sites (from 1.1 +/- 0.3 mm at baseline to 1.4 +/- 0.5 mm at 6 months) to the control sites (from 1.1 +/- 0.3 mm at baseline to 1.1 +/- 0.3 mm at 6 months). In the case of PD, there was no significant difference between the two groups at 6 months, but a significant CAL gain in favor of the control group was observed at that time. CONCLUSIONS: MCAF is a predictable treatment for multiple adjacent Miller Class I or II recession-type defects. The addition of a PRF membrane positioned under the MCAF provided inferior root coverage but an additional gain in GTH at 6 months compared to conventional therapy.

Emdogain in regenerative periodontal therapy. A review of the literature.

The goal of regenerative periodontal therapy is the reconstitution of the lost periodontal structures (i.e. the new formation of root cementum, periodontal ligament and alveolar bone). Results from basic research have pointed to the important role of the enamel matrix protein derivative (EMD) in the periodontal wound healing. Histological results from animal and human studies have shown that treatment with EMD promotes periodontal regeneration. Moreover, clinical studies have indicated that treatment with EMD positively influences periodontal wound healing in humans. The goal of the current overview is to present, based on the existing evidence, the clinical indications for regenerative therapy with EMD. Surgical periodontal treatment of deep intrabony defects with EMD promotes periodontal regeneration. The application of EMD in the context of non-surgical periodontal therapy has failed to result in periodontal regeneration. Surgical periodontal therapy of deep intrabony defects with EMD may lead to significantly higher improvements of the clinical parameters than open flap debridement alone. The results obtained following treatment with EMD are comparable to those following treatment with GTR and can be maintained over a longer period. Treatment of intrabony defects with a combination of EMD + GTR does not seem to additionally improve the results compared to treatment with EMD alone or GTR alone. The combination of EMD and some types of bone grafts/bone substitutes may result in certain improvements in the soft and hard tissue parameters compared to treatment with EMD alone. Treatment of recession-type defects with coronally repositioned flaps and EMD may promote formation of cementum, periodontal ligament and bone, and may significantly increase the width of the keratinized tissue. Application of EMD seems to provide better long-term results than coronally repositioned flaps alone. Application of EMD may enhance periodontal regeneration in mandibular Class II furcations. The clinical results are comparable to those obtained following GTR.

[Organ transplant patients' complex periodontal treatment]. / Szervátültetett betegek ínyhyperplasiájának komplex parodontális kezelése.

The number of organ transplant patients has increased in recent years. The Cyclosporin-A (CsA) has been used at least for 20 years to control graft rejections. As many organ transplant patients also take Ca channel blocking medication this might potentiate the CsA associated gingival hyperplasia. The outcome of the comprehensive periodontal treatment was evaluated in 14 kidney and liver transplant patients. If gingival overgrowth showed no marked reduction after thorough professional supra and subgingival plaque control either gingivectomy or flap surgery were indicated. The average age of the organ transplant patients was 38 years. 10 was man and 4 female. The daily dose of CsA ranged between 150-200 mg, and each patient took also Ca channel blocking drugs, 5-20 mg/day. S/RP alone was successful in two cases. Gingivectomy was performed in 10 cases and flap operation was indicated in two cases. Among patients with high compliance and excellent individual oral hygiene no recurrence occurred, while two patients with very low level of oral hygiene showed immediate gingival overgrowth after surgery. It is supposed that dental plaque is an important contributing factor in the development of drug induced gingival overgrowth and meticulous plaque control should be one of the most important treatment modalities in controlling drug-induced gingival changes.

Clinical and histologic evaluation of an enamel matrix protein derivative combined with a bioactive glass for the treatment of intrabony periodontal defects in humans.

The present study clinically and histologically evaluated healing of human intrabony defects following treatment with a combination of enamel matrix derivative (EMD) and bioactive glass (BG) or BG alone. Six patients displaying either combined one- and two-walled (five patients) or three-walled (one patient) intrabony defects around teeth scheduled for extraction were included. A notch was placed at the most apical extent of the calculus on the root surface to serve as a reference. Six months after surgery, the teeth or roots were extracted, together with some of their surrounding soft and hard tissues, and processed for histologic evaluation; a gain of clinical attachment was found in all cases. Healing in all three defects treated with EMD + BG was mainly characterized by new cementum with inserting collagen fibers and new periodontal ligament; most graft particles were surrounded by bone-like tissue, indicating ongoing mineralization. Treatment with BG resulted in epithelial down-growth and connective tissue encapsulation of the graft material in all three specimens. Reformation of cementum and periodontal ligament was observed in one of the specimens, limited to the most apical part of the defect. Formation of bone-like tissue around the graft particles was observed in only one of the three specimens treated with BG. Direct contact between the BG particles and root surface (cementum or dentin) was not observed in any of the six specimens. BG alone has low potential to facilitate periodontal regeneration. However, EMD + BG resulted in formation of new cementum with an associated periodontal ligament, as well as enhanced mineralization around the BG particles.

Histologic evaluation of human intrabony defects following non-surgical periodontal therapy with and without application of an enamel matrix protein derivative.

BACKGROUND: Surgical periodontal treatment with enamel matrix protein derivative (EMD) has been shown to promote periodontal regeneration. However, it is not known whether nonsurgical periodontal therapy with additional subgingival application of EMD may also enhance periodontal regeneration. The purpose of this study was to clinically and histologically evaluate healing of human intrabony defects following non-surgical periodontal treatment with and without application of EMD. METHODS: Sixteen patients, each of whom displayed one advanced intrabony defect around teeth or roots scheduled for extraction, were included in the study. The defects were treated as follows: 1) scaling and root planing with hand instruments and application of EMD; 2) scaling with an ultrasonic instrument and application of EMD; or 3) scaling with an ultrasonic instrument alone. Healing was uneventful in all cases. Six months after surgery, the teeth or roots were extracted together with some of their surrounding soft and hard tissues and processed for histologic evaluation. RESULTS: Clinical examination revealed a probing depth reduction and a gain of clinical attachment after all 3 treatment modalities. The histological evaluation, however, revealed that healing in all 3 procedures was predominantly characterized by formation of a long junctional epithelium along the instrumented root surface and no predictable regeneration of attachment apparatus. CONCLUSION: Within its limits, the present study failed to show periodontal regeneration in advanced human intrabony defects following non-surgical treatment with subgingival application of EMD.

Clinical and histologic evaluation of human intrabony defects treated with an enamel matrix protein derivative combined with a bovine-derived xenograft.

The purpose of the present case report study was to clinically and histologically evaluate the healing of deep intrabony defects following treatment with either a combination of an enamel matrix protein derivative (EMD) and a bovine-derived xenograft (BDX) or with BDX alone. Three female patients with generalized marginal periodontitis and presenting one advanced intrabony defect each were treated with either a combination of EMD + BDX (two defects) or with BDX alone (one defect). The postoperative healing was uneventful in all three cases. Six months after surgery, a gain of clinical attachment was measured at all treated sites. The histologic examination revealed that all three defects healed with a new connective tissue attachment (ie, new cellular cementum with inserting collagen fibers) and new bone. Most of the BDX particles were surrounded by a bone-like tissue. No direct contact between BDX particles and the root surface (cementum or dentin) was observed. Within their limits, the present data indicate that treatment with either EMD + BDX or with BDX alone may enhance the formation of new connective tissue attachment and new bone in human intrabony defects.

[Experience with the clinical use of beta-tri-calcium phosphate (Cerasorb) as a bone replacement graft material in human periodontal osseous defects]. / A beta tri-calcium phosphate (Cerasorb) klinikai alkalmazásával nyert tapasztalatok humán parodontális csonthiányok pótlásában.

Various bone replacement graft materials have been used in attempting to restore periodontal bone structure lost as a result of periodontal inflammation. The pure beta-tricalcium phosphate has been successfully used in oral surgery for replacing lost bone but the periodontal data available are very limited. The major objective of the present clinical trial is to evaluate the regenerative-reparative potential of beta-tricalcium phosphate (CERASORB) in the treatment of two-three-wall vertical periodontal bony defect. 21 patients with advanced intrabony defects were selected for this study. Parameters used for assessment: Bleeding on probing, Clinical Probing Depths (CPD), Clinical Attachment Loss (CAL), Clinical Gingival Recession (CGR) and Radiological evaluation on standardized periapical radiographs. Following local anesthesia, intracervicular incisions is placed and a full thickness mucoperiosteal flap is raised vestibularly and lingually. The granulation tissue was completely removed from the defects and the roots were thoroughly scaled and planed using hand and ultrasonic instruments. Osseous recontouring was not performed. Following defect debridement, the CERASORB bone-grafting material was carefully applied and gently condensed in the bone crater then the flaps were repositioned in a coronal position and closed with vertical or horizontal mattress sutures. Six months after surgery CPD, CAL and CGR parameters were also measured and compared to baseline data. Bone defects treated with beta-TCP bone grafting materials showed a great variation in healing tendency. The best radiological results (bone fill) were obtained in three wall defects. Even using the most thorough suturing technique substantial part of the bone grafting material was lost during the first post-surgical week. If no sequestration occurred substantial bone fill and clinical attachment gain occurred especially in the three wall defects one year after grafting. The use of biological barrier membranes are recommended.

Presence of an enamel matrix protein derivative on human teeth following periodontal surgery.

An enamel matrix protein derivative (EMD) has been successfully employed to restore fully functional periodontal ligament, cementum, and alveolar bone in patients with severe attachment loss. When applied to denuded root surfaces, EMD is believed to assemble into a matrix that locally stimulates regenerative responses in the surrounding tissues. Since wound healing and induction of regeneration are biological processes typically running from weeks to months after treatment, the EMD matrix must be present on the root surface over a biologically significant time period to be effective. So far, no studies have been done in humans on the persistence of EMD on the treated root surface. The aim of the present study was to investigate the persistence of the EMD-based matrix on periodontally involved human teeth treated surgically with EMD. Sixteen patients with one intrabony defect each around teeth scheduled for extraction due to advanced periodontitis were treated by means of access flap surgery with and without application of EMD. At 1, 2, 3, and 4 weeks postsurgery, the teeth were removed and processed for histology and immunohistochemistry. The slides were stained using a rabbit anti-enamel-matrix-derivative (anti-EMD) antibody and goat-antirabbit secondary antibodies labeled with horseradish peroxidase (HRP). Immunohistochemical evaluation demonstrated the presence of EMD on all test root surfaces during the entire observation period of 4 weeks. No EMD was detected on any of the control roots. The results demonstrate for the first time in humans that EMD is present on treated root surfaces for up to 4 weeks following periodontal surgery.

[Treatment of periodontitis associated with cyclosporin-induced severe gingival hyperplasia with regular mechanical plaque removal in a patient with renal transplantation (Case report)]. / Cyclosporin-A okozta súlyos ínyduzzanattal társuló parodontitis kezelése rendszeres mechanikus plakk-kontrollal vesetransplantált betegen (Esetismertetés).

A clinical case of a middle-aged kidney transplanted woman is presented. The woman has been taking Cyclosporin-A for over 13 years and has had advanced periodontitis and severe gingival swellings and gingival inflammation. The kidney transplant patient was treated and followed up for approx. four years. The treatment protocol included very thorough mechanical scaling and root planing, oral hygienic instructions and the regular professional maintenance program resulted in complete remission of the gingival overgrowth and stabilization of the periodontal condition. The gingival and periodontal conditions showed a continuing improvement over the time despite of the continuous CSA administration.